A virtual glucose management service significantly improved glycemic control in hospitalized patients

1. Implementation of the virtual glucose management service reduced the number of severe hypoglycemic events experienced by hospitalized adult inpatients.

2. The proportion of both hypoglycemic and hyperglycemic patients decreased following use of the virtual glucose management service.

Evidence Rating Level: 2 (Good)

Study Rundown: Glycemic control management is necessary to avoid adverse patient outcomes in hospitalized patients. While studies show the importance of maintaining normoglycemia in hospitalized adults, many patients’ blood glucose levels are off target from recommended guidelines. While efforts have been made to improve glucose control in patients, new methods will be required in order to ensure better patient care. One potential method is the implementation of a virtual glucose management service (vGMS). The authors of this study aimed to determine whether this service, including automated reports, clinician review, and clinical notes, is associated with improved inpatient glycemic control. In general, the authors observed that implementation of the vGMS was associated with decreases in hyper- and hypoglycemia of hospitalized patients. This study has several limitations. First, information was not collected on patients’ concurrent illness and treatment in the vGMS notes. Additionally, the staff at the hospital where vGMS was evaluated rotated monthly on different services—it would have been more effective to evaluate the effects of vGMS with a more stable staff. Overall, vGMS may be a future tool to help better control glycemic levels in hospitalized patients.

Click to read the study in the Annals of Internal Medicine

Relevant Reading: Hyperglycemia and Perioperative Glucose Management

In-Depth [prospective cohort]: In this cross-sectional study, a vGMS system was implemented at the University of California San Francisco (UCSF) in 2012. Participants were adult inpatients in all medical and surgical wards and intensive care units at the 3 UCSF acute care hospitals. Obstetric patients were not included in the study. The authors evaluated the association between implementation of the vGMS and glycemic control in adult inpatients over a 3-year period. In general, they observed an improvement in patient glycemic control after implementation of the vGMS. Specifically, the proportion of hyperglycemic patients decreased by 39%, from 6.6 per 100 patient-days in the pre-vGMS period to 4.0 per 100 patient-days in the vGMS period (difference -2.3, 95%CI, -2.7 to -2.4). Furthermore, forty severe hypoglycemic events occurred during the pre-vGMS period versus 15 during the vGMS period.

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